The politics of psychotherapy

This is an extract of a paper given at the Tent City University on the Occupy London site at St Paul’s on the 29th January 2012 and that was part of a number of presentations on psychopolitics and the politics of psychotherapy.

When talking about the politics of psychotherapy, it seems important to first recognise that therapeutic practice can not be separated form the ideological context in which it takes place. The Western dominant discourse places individualism as one of its highest values. The rights and prerogatives of individuals have acquired higher regard than for instance the development of meaningful relationships between members of a community. The ideological discourse reflects the demands of a neoliberal economy protecting free market and free will. It is to be asked how much does therapeutic practice reflect the dominant discourse and how much does it help to create an alternative discourse based on different values. It is also to be asked how much of the human mind has been privatised by seeing disturbances and disorders as private matters disconnected from the social reality where they originate.

Secondly, it seems equally important to consider the relationship between social and cultural dynamics, and individual or psycho dynamics. I support an argument that recognises a process in which they mutually influence one another. But this dynamic is very often masked and overlooked for obvious ideological reasons. It is not in the interest of the existing social order (and the dominant class) to make the link visible. Although all the signs are there to show the link, there is a conscious (or unconscious) effort to mask it. This is not surprising since the social order develops and supports a discourse that guarantees the reproduction of that order and its survival. Anything against it will be attacked as a defence against the anxiety of not having any order at all.

So, what is the system trying to hide? Or what sort of myths has the system produced? The myth is the myth of the ‘isolated self’. As if the self could be understood and conceptualised away from the context in which it exists and develops. These are the mythical grounds that claim the autonomy of the subject from the social context and that to an extent reflect early psychoanalytic views on human motivations as arising from within, not without. The risk is to de-contextualise the individual from his environment and from his relationships with others. The general social and cultural conditions in which individuals develop their difficulties have largely remained overlooked. Martín-Baró wrote that ‘dominant theories too often isolate psychological processes from the concrete sociopolitical context that first produced them and that continues to shape them’ (Martín-Baró, 1996, 95).

What we are witnessing is a process of privatisation of the mind, and I am thinking here about three different strands of privatisation. The first one refers to the privatisation of psychological disturbances and disorders disconnected from the social reality in which they occur. The second one refers to the atomisation and isolation of the person receiving treatment and object of social stigma. The third one refers to the commodification of the psyche and its commercial value.

By putting so much emphasis on the individual (like the market economy wants us to), the result has been endemic solitude and isolation. The aptitudes of individuals to connect have been eroded. The whole social fabric has been torn apart. Dissociation, fragmentation, alienation, paranoia, aggression are not just psychological processes or defences, they also reflect social dynamics (from the immediate family to the wider context and history). Self-sufficiency is the proclaimed aim, not relationship or connection. We can see how social structures and psychological understanding of human development are converging in the interest of the social status quo.

When we talk about the politics of mental health, these are the questions that we need to ask ourselves: what are the social implications of mental health care, what are the assumptions on which it is based, and what are its relations to the dominant ideology?

It seems that a shift has to take place whereby we start thinking about the relation between the ways we feel and the ways we operate socially, or to put it differently between the individual structure and the social structure. This brings me to the relationship between psychic space and social space or, between the internal structure of oppression and external structure of oppression. We have already mentioned that the way we develop individually is influenced by the environment we have been brought into. The environment (family and beyond) has been or not responsive to our needs (basic needs to more complex needs). Our needs for interaction and relationship have been met or not. From early experience, we have internalised ways of being and developed a sort of internal working model that will influence our subsequent experiences with others, our reactions, behaviours, and the way we move on in life. It is very often oppressive because it keeps us into patterns that may not be very helpful. It also limits our ability for experiencing and understanding the unfamiliar. This model is easily shaken by the anxiety that it may disappear and crumble. Understanding ourselves is as important as understanding the world. Changing ourselves is as important as changing the world.

External structures of oppression derive from the way the social structure is organised, and this includes distribution of power, social hierarchy, social relations, production and distribution of wealth, norms, culture, etc. These structures of oppression are variously distributed depending on the group we belong to and our own position within that group. These external structures permeate into the entire fabric of social relations and are continuously experienced by the individual, leaving like profound imprints.

Internal structures of oppression and external structures of oppression apply incredible force to remain as they have always been, making the process of change quite a tricky business. But the process of individual transformation and social transformation are simply two sides of the same coin. The problem is that maybe for too long they have been seen as processes separated from one another and conceptualised in isolation from each other.